DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Kris A	DOIID	762036	NAIC NPN	16239376

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	1/14/2026		1/31/2027
Active	Non Resident	Agent	Health	1/14/2026		1/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	11/15/2026	01/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American General Life Insurance Company	301585	Agent - Health	8/29/2012	1/31/2019
Inactive	American General Life Insurance Company	301585	Agent - Life	8/29/2012	1/31/2019
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	11/14/2014	10/28/2015
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	9/6/2011	12/5/2018
Inactive	Lumico Life Insurance Company	300354	Agent - Health	12/20/2018	1/31/2019
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	10/19/2011	11/14/2014
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	5/4/2018	12/5/2018
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	4/25/2015	2/15/2018
Inactive	Omaha Insurance Company	751908	Agent - Health	5/4/2018	8/8/2018
Inactive	Pruco Life Insurance Company	300954	Agent - Health	9/22/2011	12/12/2018
Inactive	Pruco Life Insurance Company	300954	Agent - Life	9/22/2011	12/12/2018
Inactive	Revol One Insurance Company	300681	Agent - Life	9/2/2011	5/31/2012
Inactive	United World Life Insurance Company	300532	Agent - Health	5/4/2018	12/5/2018
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	5/4/2018	12/5/2018
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	5/4/2018	12/5/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Efinancial LLC	598419	Agent - Life	11/3/2011	1/31/2019
Inactive	Efinancial LLC	598419	Agent - Health	11/3/2011	1/31/2019
Denied	Ethos Technologies Inc.	934675	Agent - Life
Denied	Ethos Technologies Inc.	934675	Agent - Health